Learning during COVID-19

During the COVID-19 pandemic, one of the challenges facing residents is continuing to receive high-quality learning during their training. Difficulties such as transitioning to a virtual platform, protecting residents from certain aerosol-generating procedures, and decreased patient volumes make it challenging for learners compared to the pre-COVID era. Here, we explore some strategies to help ensure that residents are progressing along their developmental arcs.

1) Virtual academic days

A full-court press, all hands-on-deck strategy is required for these academic days to function. This involves a coordinated approach from the program administrators, staff physicians, as well as residents. There are a variety of online platforms available that can be used to upload slides and allow many listeners to sit in at once. Some strategies that learners have found useful include:

Small groups are helpful for discussion.

Break the session up into smaller groups to have a “flipped classroom” style. This can be done by having multiple “smaller rooms” online (~5 – 8 learners of various years) going through quiz style questions. The teacher can then go into rooms as needed, which helps to generate discussion. You can then reconvene in the “larger classroom” to go through a more didactic style of teaching.

Have a moderator.

This person is key to allowing the session to function well. Have this person take note of questions and bunch them to the teacher at an appropriate time

Utilize the microphone

Participants should ask and answer questions with the microphone when possible. When utilizing the chat function, this should be relevant to the topic on hand and remain professional, as it can be distracting to the learners and lecturer!

Be ok with silence.

It takes time for people to unmute their microphones and think of an answer to your questions. As a teacher, be patient and allow for this “awkward silence” to pass by!

Be receptive to feedback.

This is a new platform for both the presenter and the learner. There will be lots to change week-to-week, but this will help the learning experience overall exponentially.

Practice makes perfect

Make sure your microphone, video, and slides are working prior to the session. It only takes a couple minutes to troubleshoot and it makes a world of a difference for game day!

The research world is still ongoing, and now more than ever, it is important to know how to critically appraise articles, and journal club provides a great medium to do so. Locally, we have transitioned to a virtual format. Each month, 3 residents will each choose a paper to lead a critical appraisal. The participants attending will complete a worksheet for each paper. Afterwards, a discussion will be led by the resident who chose that article and a staff moderator who will help facilitate and provide epidemiologic lessons. This is a great way for everyone to keep up to date on the literature!

3) Virtual simulation curriculum

Simulation is more than just practicing procedures and resuscitation with a mannequin. Simulation provides an opportunity to mentally rehearse various high yield, high fidelity resuscitation scenarios. We have transitioned to a virtual simulation model, where we can still practice these scenarios in a safe space. For example, going through the mental exercise of managing a post-partum hemorrhage including crisis-resource management, situational awareness, and active medical therapy, will prepare trainees for when this deadly disease presents to the ED.

4) Learning with lower patient volumes

Emergency physicians tend to not sit down for long periods of time before getting antsy. Patient volumes have decreased initially during the pandemic (thanks in large part to assessment centers!). One tip when this occurs is to ask your staff questions and nuances for any patient that you see. E.g.: patient with symptoms of a stroke. What would your approach be if you were in a remote site without neurology? What if you did not have a CT scanner? What are some practice specific nuances you’d like to know more about? These are all questions that you should ask yourself to push your limits as an emergentologist.

This is also a great time to ask for direct observations (e.g.: obtain multiple Entrustable Professional Activities) and hands-on teaching. When was the last time you had someone comment on your suturing technique? What are some tips to position patients for an LP that can yield higher success? What about how to obtain verbal consent, or different styles in giving important discharge instructions? Every staff physician has a lot to offer – learn from each one and develop your own style for the future!

5) Learning during intubations

Resident roles during intubations vary by institution. Intubation is one of the highest risk procedures in COVID-19 patients, and if you are not the one intubating, there is still lots to learn. Let’s breakdown some learning opportunities if you’re inside versus outside the room.

Inside the room

The peri-intubation and immediate post-intubation periods are the most dangerous aspects of a resuscitation. It is important to note that the act of intubation is just one aspect. Although airway management is a crucial skill for an emergentologist, by leading the resuscitation you have a more important role. When the other MD is intubating, you are now in charge. This is your chance to work on your resuscitation leadership, crisis resource management, and situational awareness skills.

Outside the room

Just because you are not in the room does not mean that you are not actively learning. Ask to go through the plan with your staff including what your plan would be, sit outside the room, and watch what your staff is doing. One helpful strategy is to have an audio device (phone, baby monitor, walkie-talkie) and listen to how your staff is orchestrating the room. This is akin to watching game tape. Remember, in just a few years, this will be you. Soak it in like a sponge! Additionally, ensure you have the opportunity to debrief and ask questions after !

6) Teaching others

One of the best ways to learn is to teach others of all levels. Unfortunately due to COVID-19, medical students are not rotating through the emergency department. However, that does not mean that you can’t help their education. In fact, this is the best time for you to put on your “clinician-educator” hat! In our department, we continue to teach medical students via virtual platforms. This includes:

UGME clerkship students: ED residents continue to teach core emergency medicine topics. These are akin to an “ED bootcamp” and a combination of peer-assisted learning and didactic teaching.

Elective students: We know CaRMS is going to be very different this year as it has gone virtual and many electives will be canceled. As such, we have opened up our academic day to medical students across the country (and IMG’s as well!). A limited number of medical students per week are able to come join our case rounds and grand rounds. We have also started a summer symposium to discuss core emergency medicine topics, which will be taught by 1 staff and 1 resident physician. This is a great opportunity for residents to teach students, as well as receive feedback on their teaching styles!

Bottom Line

Although COVID-19 has changed resident and medical student training, this does not mean our learning has stopped. This is our chance to be creative with the various ways to teach learners, and to continue improving every day. Remember, one day, it will be us leading the charge.

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World-Class Emergency Medicine: To provide outstanding compassionate emergency care through practice-changing research and innovative medical education. For more about our department, visit us at EMOttawa.